Of course not. I don't believe the redistribution of weath is a proper government function. I support a flat tax on individuals. I'm saying that, since taxes are a necessary evil; we might as well apply them in a way that encourages economic development in the US rather than discourages it.
A flat tax is inherently unfair, the poor need higher percentage of their income for food and shelter and basic survival, the rich need a far smaller percentage. Your just calling it something else, your taxing the rich, perhaps not directly but that what your doing, calling it "smart tax laws" is akin to calling socialize medicine, "single payer medicine".
Most flat tax proposals don't start taxing income until it hits 20k or so. This means that if you make 40k, you're only taxed on 20k; so if the tax rate was 10% your effective tax rate would be 5%. Someone who earns 500k, on the other hand, would end up paying an effective tax rate of 9.6%. How is that not fair? No, the higher taxes wouldn't be based on income; but how the money is spent. Of course the "rich" would end up paying more taxes, that's true even under a flat tax. Frankly, I think our present system is the most unfair because our tax code is so full of loopholes that many of the truly rich end up paying very little in taxes. Many loopholes are written into law specifically to benefit a certain company. A simple flat tax with no loopholes might well have "the rich" paying more in taxes. But, regardless, they'd be paying their fair share.
than its not really a true "flat tax", its progressive, I like it. Like I said, your just proposing an indirect way of doing the same thing. Sneaky, but I'm very much for it. Completely agree, a radically simplified tax system would do way with that, I always like the idea of a federal sales tax, though split off into a manufacturing tax (tax it before it reaches the consumer to prevent black tax free marketing) combined with massive tariffs (if your going to have nearly slave like labor in some 3rd world country making your product will make you pay in tariffs.).
which leads us neatly to one of the great contradictions of conservatism - particularly (but not exclusive to) American conservatism. Namely that there are greater and higher things to aspire to than simply the individual and his or her individual desires - like their country, patriotism, service, values, and loyalty. what greater, more patriotic service could an individual provide to their fellow countrymen than to do your bit to ensure that they all, regardless of status, have access to the basic medical care that everyone in the civilised world gets for free? Free universal healthcare has nothing to do with redistribution of wealth - its about patriotism - its about freedom by ensuring the freedom from debt bondage and bankruptcy, its about family values by ensuring that families arent torn apart from being forced to make impossible choices over paying for the healthcare of loved ones. That kind of justice is the very essence of conservatism. Free universal healthcare is - in short - at the very heart of conservative values - unfortunately American Conservatism has been hijacked by misanthropy, greed and selfishness, and lost sight of its true values.
Dude, that's my doctor .... Okay, this is so cool. Please Register or Log in to view the hidden image! Dude, that's my doctor! Dr. Martin Cahn, at his office in Seattle's Fremont neighborhood. (Photo by Richard Darbonne) I met this guy a decade ago. It was, you might say, a stroke of luck. Living at the corner of 39th and Fremont, choosing a primary care physician for a health insurance plan for the first time in my life, I literally picked Dr. Martin Cahn because his office was just down the street. I could walk there if I wanted to. And I did. From the outset, I liked him. He had this gruff bedside manner that might put some off, but it was direct. As I described a particular problem I was having, I recalled a prior visit to a HealthSouth clinic and told him about the tests they had run. "Why?" he asked, then wrote a prescription and gave me the number of a specialist he was referring me to. His unspoken mission is the long-term health of his patients. I turned up at his office one day after a couple years without a checkup, and as he looked through my record, recalling his prior efforts to get me to stop smoking, he didn't bother asking. He simply wrote a prescription and said, "It's new. It works. Try it." Eric Scigliano featured Dr. Cahn in the August, 2009 issue of Seattle Metropolitan magazine in an article that covers everything from his practice to the nature of health care in Seattle and the nation, insurance, big pharma, and even that problem called Oprah. This visit, a routine checkup, was also a personal milestone for Ryan, and an example of the difference an old-fashioned family doctor can make in one patient’s life, above and beyond what’s commonly labeled “medicine.” Ryan is as ebullient as the toddler he was when he first saw Cahn. “I’ve lost weight,” he said proudly. “I want to get down to 280. But I assume my blood pressure is high ....” Cahn checked it, frowned darkly, but said nothing; he didn’t want to kill his patient’s buzz. Ryan had big news. Next year he’ll be attending a top-flight school, Purdue University. “And it was this guy who got me to do it,” he beamed, pointing to his doctor. “He was the one who told me, ‘Apply to colleges!’ even when I didn’t think I could do it.” A year ago it was by no means obvious Ryan could do it. “You’ve always been an extraordinarily smart guy, Cameron,” Cahn told him. “You just needed to focus.” In junior year Ryan was flailing. Then a belated diagnosis of attention deficit hyperactivity disorder and the resultant drug regimen turned him around. His grades and SAT scores soared. “Any idea what you’re going to major in?” Cahn asked. “I don’t know, probably psychology. I’m also interested in business, but I don’t know if there will be any jobs in it when I come out. I figure there will always be work helping messed-up people.” “My advice is to have a great time at college and try as many things as you can,” said Cahn, and for the second time that day he segued into The Story, the one he likes to tell patients trying to figure out how to live their lives .... (Scigliano) One challenge facing the American health care system is apparently the declining number of new doctors entering primary care. Presently, approximately 30% of American doctors work in primary care; since 1997, though, the number of new doctors entering primary care has fallen to about 13%. This, of course, has much to do with compensation: That’s far fewer than in other industrialized nations, where half or more of doctors work in primary care. But despite dire predictions, America’s primary-care corps hasn’t yet collapsed, for one reason: immigration. We import doctors to perform the work American docs don’t want to do, just as we import farmworkers, dishwashers, and housekeepers. And we do so for the same reason: We pay them less than Americans want to work for. In 2007 the median pay for primary care doctors was $182,000, much less than the median $460,000 for orthopedic surgeons, $464,000 for radiologists, and $332,000 for specialists overall. Physicians often cite the years and money they spend to become doctors to justify their incomes. Many come out of med school with forbidding debts—$150,000, $200,000, sometimes $300,000. They can easily spend as much again to establish a practice. “If I’d come out of school owing a quarter million dollars, I might feel differently myself,” Cahn admits. The big problems with importing doctors are settlement patterns and ESL. Incoming foreign doctors apparently settle more in cities, but it is rural areas where primary care is most needed. And while their medical skills are fine in and of themselves, the nuances of American language and customs are not so well possessed. This can present some communication challenges on occasion. And as long as we're considering urban/rural, we might as well also note that these doctors are needed even more in many of their countries of origin. It's a difficult means for delaying a potential crisis. A ream of studies shows that more primary docs relative to population means lower death rates, in particular from heart disease and cancer. Primary physicians monitor the entire patient, not just particular organs. They catch ailments early, before they become crises and require costly tests, treatments, and hospitalization, all of which carry risks. “I tell patients I’m available anytime,” said Cahn. “I’d rather hear about a problem at 2am than an emergency at 6.” He still remembers the patient who didn’t call the night he felt chest pains “because he didn’t want to wake anyone up” and by morning had a massive heart attack. He's even more of an old-fashioned doctor than I had previously realized. Scigliano writes that he is the last primary care doctor left in lower Fremont, but that's hardly as dramatic as it sounds. It would be nice if he had some fellows in the neighborhood, but it's not so far to Ballard, Wallingford, or even the University District; folks in Fremont—and Seattle in general—aren't hurting for health care as much as in other places around the state and country. Cahn had a lunchtime appointment, with pharmaceutical sales reps rather than patients. He grimaced. “Thirty years ago the drug reps were mostly retired pharmacists,” he said. “They knew their stuff, and you could pretty much take what they said. Now they’re pretty young things who wanted to be models.” One of the two reps was a tall young woman who could almost be a model. The other was a short young man dressed like one, in a sleek black suit, killer tie, and hipster goatee. He sustained a salesman’s grin; she looked faintly embarrassed. They delivered coffees and pastries from the staff’s favorite espresso stand. “They know I can be bought cheap,” Cahn joked. He stood stony-faced, and they didn’t even bother with a spiel. (“They already know I hate them,” he said afterward. “And they know exactly what I prescribe and how much. Pharmacies sell that information.”) The reps delivered their samples and made their escape. “These are nearly the only reason I see the reps,” Cahn explained, depositing the samples in a cabinet packed with pharma swag. He gives them to patients who don’t have coverage for meds; for some they’re a lifesaver. That afternoon Edge Newcomb, a restaurant worker–turned–independent filmmaker, stopped by for the inhalers that control his allergies and chronic bronchitis. “I’ve always liked coming here,” he said. “Dr. Cahn is like an old-fashioned doctor. I’ve gone to others, but it seemed like cattle farming. You feel like they’re hosing down the seats between patients.” Cahn handed him a bag of inhalers. “These would cost a couple hundred dollars a month. I can’t afford that,” said Newcomb. “Thank you again!” he called on his way out. “You’re very welcome,” Cahn replied without looking up. “I wish I could give you more.” And, of course, part of his neighborhood doctor routine is brought on by the one great frustration of being a doctor: “I love medicine,” Cahn mused during a lull. “I like helping people. I’ve enjoyed every part of it—except dealing with the insurance companies.” He scowled. “It’s an incredible source of friction in the system.” So he'll find ways to help people afford the care they need. But he also has had to cut services. He has stopped taking new Medicare and Medicaid patients except under what he considers extraordinary circumstances. And, having delivered only one baby in the second half of last year, he decided the $12,000 premium for obstetric insurance just wasn't worth it. That's sad. He received into this world over five hundred new people, and used to maintain a wall with photographs of as many of the children he helped deliver as parents would send. But he's not alone. While many people have lost faith that the market will repair itself, it is demanding that everyone adapt to changing circumstances. Cahn’s not the only one feeling the squeeze. Some physicians are “going bare,” dispensing with malpractice insurance. Others shake off the shackles of medical insurance, taking only cash—usually affluent—patients. Seattle is a hotbed of this “direct practice” rebellion; high-end “concierge care”—your personal doctor holds your hand even when you visit specialists, like a lawyer accompanying you to court—started here in 1996. It can cost $1,000 a month or more. A minority of direct practices offer unlimited primary care for monthly fees ordinary workers can afford. One, sponsored by Swedish Medical Center, charges just $45. Now a brash Seattle start-up, backed by early Amazon investor Nick Hanauer, proposes to do for direct practice what Starbucks did for espresso. Qliance’s founders include two physician cousins, Garrison and Erika Bliss, who like Cahn were fed up with what their CEO, Norm Wu, calls the “hamster-wheel -model” of insurance-driven medicine. Qliance’s downtown Seattle prototype offers a “medical home”—primary, urgent, wellness, and preventive care, open seven days a week—for $39 to $79 a month depending on age, more if you want to make hospital visits. Its doctors (for now, anyway) have about 800 patients each, versus the usual 2,000 to 3,000. They gladly answer questions by phone. So does Cahn, but it costs him. Insurance doesn’t pay for phone calls, only office visits, one reason receptionists typically ask you to just make an appointment You'll notice I skipped the bit about Oprah. (Come on, read the damn article.) There's also a great picture of Dr. Cahn in younger years, but hey. While the details of his personal career might vary as much as diversity suggests, I don't think Dr. Cahn is unique insofar as the themes of the challenges facing doctors in the United States. Over the years I've seen the number of insurance carriers he will deal with crash. And many of his patients are like me, anyway. We pay cash to make sure we're healthy, and we'll figure the rest out when something goes wrong. That bugs him to a certain degree, but his response is to try to help us stay as healthy as possible in the meantime. In terms of personal and professional principles, you can't ask for much more. But in terms of social principles, the fact of the situation is a testament to its impropriety. Plenty of us understand that's how it goes; but should it really be that way? ____________________ Notes: Scigliano, Eric. "The Doctor Is In a Fix". Seattle Metropolitan. August, 2009. SeattleMet.com. December 2, 2009. http://www.seattlemet.com/health-and-fitness/articles/health-primary-care-0809/
Me too, that's why I support a progressive tax. When lower income citizens are taxes progressively less, they have money to spend on things, which creates demand, which creates businesses.
I have a question if the government is so inefficient why does the US have one of the highest medical loss ratios
